Recreational Nitrous Oxide Abuse-Induced Vitamin B12 Deficiency in a Patient Presenting with Hyperpigmentation of the Skin

  title={Recreational Nitrous Oxide Abuse-Induced Vitamin B12 Deficiency in a Patient Presenting with Hyperpigmentation of the Skin},
  author={Tsung-Ta Chiang and Chih-Tsung Hung and Wei-Ming Wang and Jiunn‐Tay Lee and Fu-Chi Yang},
  journal={Case Reports in Dermatology},
  pages={186 - 191}
Vitamin B12 deficiency causes skin hyperpigmentation, subacute combined degeneration of the spinal cord, and megaloblastic anemia. [] Key Method Here, we describe the case of a 29-year-old woman presenting with skin hyperpigmentation as her only initial symptom after N2O abuse for approximately 2 years.

Figures from this paper

Vitamin B12 deficiency-induced neuropathy secondary to prolonged recreational use of nitrous oxide.

Skin hyperpigmentation: a rare presenting symptom of nitrous oxide abuse

Skin hyperpigmentation is a rare symptom in N2O abusers, which can distribute locally in hands or diffusely throughout the body, and attention should be paid to a history of N 2O abuse and serum vitamin B12 level should be tested.

Inhaled nitrous oxide-induced functional B12 deficiency

A 19-year-old man presented to the emergency department with a 4-week history of worsening paraesthesia in his fingers and lower limbs, and weakness in the hands and lower limb for 2 weeks, and an MRI brain and spine revealed myelopathy of the cervical and thoracic cord.

Myelopathy Secondary to Vitamin B12 Deficiency Induced by Nitrous Oxide Abuse

A case of a patient presenting with acute onset of numbness who was ultimately diagnosed with myelopathy secondary to vitamin B12 deficiency induced by nitrous oxide abuse is outlined.

Subacute Combined Degeneration of the Dorsal Columns in A Patient With Nitrous Oxide Induced B12 Inactivation: A Case Report

A case of a 28 year old patient who abused N2O, then went on to develop neurologic symptoms of ataxia, numbness and subacute combined degeneration of the dorsal columns as seen on MRI, whose symptoms were consistent with vitamin B12 deficiency despite having normal vitamin B 12 levels by conventional lab measurements.

Recreational Nitrous Oxide Abuse: Prevalence, Neurotoxicity, and Treatment

The epidemiology of N 2 O abuse, neurotoxicity mechanisms, clinical manifestations, relevant auxiliary examinations, treatments, and prognosis are discussed to improve social awareness of N 1 O exposure risk, especially among users and clinicians.

Does vitamin B12 deficiency explain psychiatric symptoms in recreational nitrous oxide users? A narrative review

The need to recognize that psychiatric symptoms may appear in association with nitrous oxide use is highlighted, and Psychiatrists and emergency physicians should be aware of isolated psychiatric symptoms caused by recreationalNitrous oxide abuse.

Imaging appearance of myelopathy secondary to nitrous oxide abuse: a case report and review of the literature

The onset of the disease was usually subacute, the majority of patients were young men, and there was no definite relationship between myelopathy and the amount or duration of N2O inhalation.

One month of nitrous oxide abuse causing acute vitamin B 12 deficiency with severe neuropsychiatric symptoms

A 21-year-old university student studying abroad in the USA presented to the emergency department with double vision, lower extremity weakness with difficulty ambulating and other neuropsychiatric symptoms and was discharged on vitamin B12 supplementation.

Recreational nitrous oxide-associated neurotoxicity

A previously healthy 21-year-old woman presented with subacute onset of confusion and gait ataxia. She reported habitual inhalation of nitrous oxide (N2O) purchased online over the past year, with



Epidermal changes in vitamin B 12 deficiency.

Epidermal cells in areas of pigmentation were found to have abnormally large nuclei similar to those previously described in the mucosal epithelium of patients with vitamin B 12 deficiency, supporting the assumption that these enlarged nuclei were indicative of the deficiency.

Cobalamins and nitrous oxide: a review.

The anaesthetic gas, nitrous oxide (N20), once regarded as chemically inert, oxidises some forms of vitamin B12. It does this both when used clinically and in the test tube, and the action is

Clinical aspects of the interaction between nitrous oxide and vitamin B12.

  • J. Nunn
  • Chemistry
    British journal of anaesthesia
  • 1987
There was thus a parallel with megaloblastic anaemia and a working hypothesis for the agranulocytosis and the teratogenesis which had previously been observed as toxic effects of nitrous oxide.

Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency-related neurological syndromes.

A high index of suspicion of B12def is required in patients presenting with myelopathy, cognitive decline, or neuropathy; therefore, other tests such as bone marrow smear and serum vitamin B12 assay are essential, as the condition is often reversible with treatment.

Hyperpigmentation of Skin

This paper describes some of cases and the investigations undertaken to establish the aetiology of the pigmentation associated with vitamin-B12 deficiency in subjects with tropical sprue and tropical megaloblastic anaemia.

Neuropathy following abuse of nitrous oxide

A disabling peripheral neuropathy developed in three health workers who habitually abused nitrous oxide, with patterns of numbness that were radicular rather than purely distal, and a “reverse” Lhermitte sign, in the absence of signs of spinal cord involvement.

Clinical practice. Vitamin B12 deficiency.

  • S. Stabler
  • Medicine
    The New England journal of medicine
  • 2013
Vitamin B12 deficiency causes reversible megaloblastic anemia, demyelinating disease, or both. Current assays have insufficient sensitivity and specificity; methylmalonic acid levels are useful to

Folate/vitamin B12 inter-relationships.

Folate deficiency causes anaemia owing to impaired purine and pyrimidine biosynthesis. Vitamin B12 deficiency causes an identical anaemia owing to metabolic trapping of intracellular folate. Vitamin